Operative Versorgung von HWS-Verletzungen

The three most frequent sources of complications in the treatment of cervical-spine injuries are the indications adopted, the access route used, and the implant selected and its application . The management of complex injuries can be significantly facilitated if it is implemented with due consideration for the basic premises of spinal surgery: the operator must be familiar with the biology and mechanics of the vertebral column and with the potentials and limitations of the implants available for selection and must have analysed the actual instability in each case. There are also critical segments that have different biomechanical characteristics from the other sections of the spine. Some pathologic conditions also involve problems peculiar to themselves in addition to such anatomical characteristics, and these thus affect the choice of surgical procedure. In such situations (fractures associated with ankylosing spondylitis, unstable fractures at the cervicothoracic junction, insufficient anterior support with dorsal instrumentation, stabilization with incomplete reduction, multisegmental instability) excessive strain on the implant must be expected, which entails the risk of early implant failure, especially if the associated biomechanical condition is misinterpreted.